09070010 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � � � �� �
BUILDING ADDRESS: PERMIT NO.
22185 RAE LN LINDY ROOFING COINC 09070010
OWNER'S NAME: PERMIT ISSUE DATE
M1 nWETT—K110 ANT) CLIATT 3 l-)()T.T.V (I
IONE: S'A1Aq11t'A9Vk0,?9 0 9 CONTROL NO.
(408) 281-)-9990
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�o c LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
i withSection7defofDivision 3ofthe Business and ProfcssiumCode,and myliccruscis RE—RF R]4V EXTNG WDSHK &IINSTL 30# FLT & 1/2 OSB
n H in full fare and effec a , 6
Dnz License Class Lle.n 0 W/36 SQ LIFETIME COMP SHNGLS CLS A
3 E,O Da tc =zzuz Contractor
RCHr1ECTS DECLARATION
I understand my plans shall be used as public records
r
U.in Licensed Professional
n y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
in O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
K E which requires a permit to construct.alter,improve,demolish,or repair any structure
y Z prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y.F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $14000
y - that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500). 35607065) . 00
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
[:11.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this reason
OwnerDate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury uric of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Cor 5lm rasa.on I surarhce mer and Policy number are:
CarrieA f t JLu CA Policy No.:/9 J P4f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be dccmcd revoked.
z R CONSTRUCTION LENDING AGENCY
[~-h I hereby affirm that there is a constuctinn lending agency for the performance of
(Y the work for which this permit is issued(Sec.3097,Civ.C.)
;3,Q Lender's Name
a z Lenders Address
U 0 1 certify that I have read this application and state that the above information is
V.t"' cormI agree to comply with all city and county ordinances and state laws relating to
O Vbuilding construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
hF-u liabilities,judgments,co and expenses which may in any way accrue against said City
U Z in consequence of the g tin of this permit Date —�
APPLICANT UNDE D AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE REGU
Re-roofs
Signature ofAppli&WonLractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cede,Section 25532(a)7 All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes 0 N
Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove
t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials r inspection.
strict?
❑Yes ❑No
1 have read the ia7tardAos materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety C , ons 25505,25533 and 25534.1 umdcrstand that if the building
does not currently ha a that it is my responsibility m notify the occupant of the
requirements whi met prior to issuance of a certificate of Occupancy. Signatur Applicant Date
'+ All roof coverings to be Class" `'or better
Owner or authorized agent Dare
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot :
APN . . . . . . . . : 35E07066 . 00
DATE ISSUED. . . . . . . : 07/02/2009
RECEIPT #. . . . . . . . . : BSC00008108
REFERENCE ID # • . . : 09C70010
SITE ADDRESS . . . . . : 22185 RAE LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER WU WEI-KUO AND CHANG DOLLY C
ADDRESS . . . . . . . . . . : 22185 RAE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4032
RECEIVED FROM . . . . : LITDY ROOFING CO IN
CONTRACTOR . . . . . . . : RUb;FORD, LINDY LIC # 3921
COMPANY LIrDY ROOFING CO INC
ADDRESS 47E W TAYLOR ST
CITY/STATE/ZIP . . . : SAY JOSE, CA 95110
TELEPHONE . . . . . . . . : (4C8) 286-9990
FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 14, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 14, 000 . 00 1 .40 0 . 00 1 .40 0 . 00
1REROOFRES SQ FEET 36 . 00 468 . 00 0 . 00 468 . 00 0 . 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 470 .40 0 . 00 470 .40 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
Oo-7( l
CITY OF CUPERTINO
i REROOF
CUPEkTiNO PERMIT APPLICATION
APN#
&0//--
-70 Ca Ca • b `' Date:
i
Building Address: --i
,2
Owner's Name: Phone #:
Contractor: , Phone #: (� _ -(, Q
Fax
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
I
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles
pE�-`Asphalt Shingles
,$C Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Q Other(Specify) ❑ Other(Specify)
Number of existing coverings — �— ❑ Provide I.C.B.O. Report h _
be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Uu;rt_r 2X-i sby 0c�
_26 Vi
C c.
Residential Commercial ❑
i
Fire Zone: Yes ❑ No (�]/ Confirmed with Planning Dept. if 1
there are any restrictions: LJ
Valuation: {
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sign --
aem,
CITY OF CUPERTINO
REROOF
#:UPEkTINO FEE SCHEDULE
Number of Fee ID Fee Descrij:)tion Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
/ 1 BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Re,,idential B
1 BUSLIC Business Li-,ense B
Community Development Department
Building Division
City of Cupertino
10300"Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the C:.ty of Cupertino
1. Prior to pk•rnut issuance, you must agree to comply with "1997 UBC Standards
and manufacturers specifications on re-r.)ofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without firA obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail ins,)ection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can by scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " p?r foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stited policy on re-roofing.
Homeowner's Name: , of r,^
Job Site Address:
c
Roofing Company Nanne:
c
Applicant's Signature. mss--- Date: ?- �
Greg Casteel
Building Official
Revised 11/2/04